Jesse Ryan Cardin, LCSW
Individual provider Active NPI Clinical Social Worker · Volcano, HI
NPI 1801437314 · NPPES record last updated Jul 6, 2023
Key facts
- NPI
- 1801437314
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 64271 (TX)
- Practice address
- 11-3784 2ND St
Volcano, HI 96785 - Phone
- (210) 527-8755
- Fax
- (210) 714-9757
- NPI assigned
- Oct 6, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
5050 Quorum Dr
Suite 700
Dallas, TX 75254-1410
Phone (210) 761-4480
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191227001809 | TX | Practitioner - Clinical Social Worker | 6002240082 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64271 | TX | MD | Professional Counselor |
| LCSW-5041 | HI | MD | Clinical Social Worker |
| 61390269 | WA | MD | Clinical Social Worker |
| 54271 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Awaken Insight | Clinical | Current |
Accepting new patients |
| Awaken Insight Counseling Licensed Clinical Social Worker PC | Clinical | Current | Accepting new patients |
Locations
5050 Quorum Dr
Ste 700
Dallas, TX 75254
Phone (214) 402-0101
2186 Jackson Keller Rd
San Antonio, TX 78213
Phone (210) 446-9552
4242 Medical Dr
Ste 7250
San Antonio, TX 78229
Phone (210) 504-6393
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 61390269 | WA | |
| Clinical Social Worker | 1041C0700X | LCSW-5041 | HI | |
| Clinical Social Worker | 1041C0700X | 64271 | TX | Yes |
Addresses
Primary practice location
11-3784 2ND St
Volcano, HI 96785
Mailing address
2186 Jackson Keller Rd
PMB 3081
San Antonio, TX 78213
Phone (210) 527-8755
Other providers in Volcano, HI
- Ahua Life Counseling, LLC
- Awaken Insight
- Anne Marie Leilani Briggs
- Nicole Bulacan
- Compassion Focused Therapy LLC
- Christin Decoito
- Elizabeth Fenton
- Gentle River Healing LLC
- Heart2Heart Counseling LLC
All providers in Volcano, HI · Clinical Social Worker in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.